Does Higher Screw Density Result in Increased Curve Correction and Improved Clinical Outcomes in Adolescent Idiopathic Scoliosis (AIS)

2012 ◽  
Vol 12 (9) ◽  
pp. S129 ◽  
Author(s):  
A. Noelle Larson ◽  
David W. Polly ◽  
Beverly E. Diamond ◽  
T. Ledonio Charles Gerald ◽  
Daniel J. Sucato ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Clinical Outcomes ◽  
Curve Correction ◽  
Density Result ◽  
Screw Density

Does Higher Anchor Density Result in Increased Curve Correction and Improved Clinical Outcomes in Adolescent Idiopathic Scoliosis?

Spine ◽  
2014 ◽  
Vol 39 (7) ◽  
pp. 571-578 ◽  
Author(s):  
A. Noelle Larson ◽  
David W. Polly ◽  
Beverly Diamond ◽  
Charles Ledonio ◽  
B. Stephens Richards ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Clinical Outcomes ◽  
Curve Correction ◽  
Density Result

scholarly journals What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US?

2016 ◽  
Vol 24 (1) ◽  
pp. 116-123 ◽  
Author(s):  
A. Noelle Larson ◽  
David W. Polly ◽  
Stacey J. Ackerman ◽  
Charles G. T. Ledonio ◽  
Baron S. Lonner ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Clinical Outcomes ◽  
Annual Cost ◽  
Pedicle Screws ◽  
Cost Savings ◽  
Screw Density ◽  
Screw Malposition ◽  
Inpatient Database

OBJECT There is substantial heterogeneity in the number of screws used per level fused in adolescent idiopathic scoliosis (AIS) surgery. Assuming equivalent clinical outcomes, the potential cost savings of using fewer pedicle screws were estimated using a medical decision model with sensitivity analysis. METHODS Descriptive analyses explored the annual costs for 5710 AIS inpatient stays using discharge data from the 2009 Kids’ Inpatient Database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), which is a national all-payer inpatient database. Patients between 10 and 17 years of age were identified using the ICD-9-CM code for idiopathic scoliosis (737.30). All inpatient stays were assumed to represent 10-level fusions with pedicle screws for AIS. High screw density was defined at 1.8 screws per level fused, and the standard screw density was defined as 1.48 screws per level fused. The surgical return for screw malposition was set at $23,762. A sensitivity analysis was performed by varying the cost per screw ($600–$1000) and the rate of surgical revisions for screw malposition (0.117%–0.483% of screws; 0.8%–4.3% of patients). The reported outcomes include estimated prevented malpositioned screws (set at 5.1%), averted revision surgeries, and annual cost savings in 2009 US dollars, assuming similar clinical outcomes (rates of complications, revision) using a standard- versus high-density pattern. RESULTS The total annual costs for 5710 AIS hospital stays was $278 million ($48,900 per patient). Substituting a high for a standard screw density yields 3.2 fewer screws implanted per patient, with 932 malpositioned screws prevented and 21 to 88 revision surgeries for implant malposition averted, and a potential annual cost savings of $11 million to $20 million (4%–7% reduction in the total cost of AIS hospitalizations). CONCLUSIONS Reducing the number of screws used in scoliosis surgery could potentially decrease national AIS hospitalization costs by up to 7%, which may improve the safety and efficiency of care. However, such a screw construct must first be proven safe and effective.

scholarly journals Higher pedicle screw density does not improve curve correction in Lenke 2 adolescent idiopathic scoliosis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Timothy J. Skalak ◽  
Joel Gagnier ◽  
Michelle S. Caird ◽  
Frances A. Farley ◽  
Ying Li
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Thoracic Kyphosis ◽  
Curve Correction ◽  
Major Curve ◽  
Curve Magnitude ◽  
Screw Density ◽  
Implant Density ◽  
Lenke 2

Abstract Purpose Higher pedicle screw density posterior spinal fusion (PSF) constructs have not been shown to result in improved curve correction in Lenke 1 and 5 adolescent idiopathic scoliosis (AIS) but do increase cost. The purpose of this study questioned whether higher screw density constructs improved curve correction and maintenance of correction in Lenke 2 AIS. Secondary goals were to identify predictive factors for correction and postoperative magnitude of curves in Lenke 2 AIS. Methods We identified patients 11 to 17 years old who underwent primary PSF for Lenke 2 AIS between 2007 and 2017 who had minimum follow-up of 2 years. Demographic and radiographic data were collected to perform regression and elimination analysis. Results Thirty patients (21 females, 9 males) were analyzed. Average age and SD at time of surgery was 14.0 ± 1.8 years (range, 11–17 years), and median follow-up was 2.8 years (IQR 2.1–4.0 years). Implant density did not predict final postoperative curve magnitude. Predictors of final postoperative curve magnitude were sex and preoperative curve magnitude. Predictors of percentage of correction of major curve were sex and age at the time of surgery. Predictors of final postoperative thoracic kyphosis were sex and percent flexibility preop. Females had lower final postoperative major curve magnitude, a higher percent curve correction, and lower postoperative thoracic kyphosis. Conclusions Increased implant density is not predictive of postoperative curve magnitude in Lenke 2 AIS. Predictors of postoperative curve magnitude are sex and preoperative curve magnitude. Level of evidence Level III, retrospective observational

scholarly journals “Higher Pedicle Screw Density Does Not Result in Improved Curve Correction in Lenke 2 Adolescent Idiopathic Scoliosis”

2021 ◽  
Author(s):  
Timothy Skalak ◽  
Joel Gagnier ◽  
Michelle S. Caird ◽  
Frances A. Farley ◽  
Ying Li
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Thoracic Kyphosis ◽  
Curve Correction ◽  
Major Curve ◽  
Curve Magnitude ◽  
Screw Density ◽  
Implant Density ◽  
Lenke 2

Abstract Purpose: Higher pedicle screw density posterior spinal fusion (PSF) constructs have not been shown to result in improved curve correction in Lenke 1 and 5 adolescent idiopathic scoliosis (AIS) but do increase cost. The purpose of this study questioned whether higher screw density constructs improved curve correction and maintenance of correction in Lenke 2 AIS. Secondary goals were to identify predictive factors for correction and postoperative magnitude of curves in Lenke 2 AIS. Methods: We identified patients 11 to 17 years old who underwent primary PSF for Lenke 2 AIS between 2007 and 2017 who had minimum follow up of 2 years. Demographic and radiographic data were collected to perform regression and elimination analysis. Results: Thirty patients (21 Female, 9 male) were analyzed. Average age and SD at time of surgery was 14.0 ± 1.8 years (range, 11-17 years) and median follow-up was 2.8 years (IQR 2.1-4.0 years). Implant density did not predict final postoperative curve magnitude. Predictors of final postoperative curve magnitude were sex and preoperative curve magnitude. Predictors of percentage of correction of major curve were sex and age at the time of surgery. Predictors of final postoperative thoracic kyphosis were sex and percent flexibility preop. Females had lower final postoperative major curve magnitude, a higher percent curve correction, and lower postoperative thoracic kyphosis.Conclusions: Increased implant density is not predictive of postoperative curve magnitude in Lenke 2 AIS. Predictors of postoperative curve magnitude are sex and preoperative curve magnitude.Level of Evidence: Level III Retrospective Observational

Preoperative pelvic obliquity: possible relation to postoperative coronal decompensation in thoracolumbar/lumbar adolescent idiopathic scoliosis

2021 ◽  
pp. 1-10
Author(s):  
Tomohiro Banno ◽  
Yu Yamato ◽  
Hiroki Oba ◽  
Tetsuro Ohba ◽  
Tomohiko Hasegawa ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Clinical Outcomes ◽  
Pelvic Obliquity ◽  
Posterior Fusion ◽  
Lumbar Curve ◽  
Fusion Surgery ◽  
The Right ◽  
Coronal Decompensation

OBJECTIVE Pelvic obliquity is frequently observed in patients with adolescent idiopathic scoliosis with thoracolumbar/lumbar (TL/L) curve. This study aimed to assess pelvic obliquity changes and their effects on clinical outcomes of posterior fusion surgery. METHODS Data in 80 patients (69 with type 5C and 11 with type 6C adolescent idiopathic scoliosis) who underwent posterior fusion surgery were retrospectively analyzed. Pelvic obliquity was defined as an absolute pelvic obliquity angle (POA) value of ≥ 3°. The patients were divided into groups according to preoperative pelvic obliquity. Moreover, patients with preoperative pelvic obliquity were divided based on POA change from preoperative values versus 2 years postoperatively. Patients were divided based on the presence of selective or nonselective TL/L fusion. Radiographic parameters and clinical outcomes were compared between these groups. RESULTS Among 80 patients, 41 (51%) showed preoperative pelvic obliquity, and its direction was upward to the right for all cases. Coronal decompensation 2 years postoperatively was significantly elevated in patients with preoperative pelvic obliquity (p < 0.05). Thirty-two patients (40%) displayed pelvic obliquity 2 years postoperatively. Among 41 patients with preoperative pelvic obliquity, 22 patients (54%) were in the group with a decrease in POA, and 19 were in the group with no decrease. The group with no decrease in POA showed significant TL/L curve progression throughout the postoperative follow-up period. The patients with nonselective fusion showed a significantly lower incidence of pelvic obliquity at 2 years postoperatively. CONCLUSIONS Postoperative coronal decompensation more frequently occurred in patients with preoperative pelvic obliquity than in those without pelvic obliquity preoperatively. In addition, postoperative pelvic obliquity changes may be related to residual lumbar curve behavior.

What happens to the unfused upper thoracic curve after posterior spinal fusion for adolescent idiopathic scoliosis?

2021 ◽  
pp. 1-7
Author(s):  
M. Omar Iqbal ◽  
Amer F. Samdani ◽  
Joshua M. Pahys ◽  
Peter O. Newton ◽  
Suken A. Shah ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Univariate Analysis ◽  
Posterior Spinal Fusion ◽  
Research Society ◽  
Curve Correction ◽  
Scoliosis Research Society ◽  
Lenke Classification ◽  
Upper Instrumented Vertebra ◽  
Upper Thoracic

OBJECTIVE Spontaneous lumbar curve correction after selective thoracic fusion in surgery for adolescent idiopathic scoliosis (AIS) is well described. However, only a few articles have described the course of the uninstrumented upper thoracic (UT) curve after fusion, and the majority involve a hybrid construct. In this study, the authors sought to determine the outcomes and associated factors of uninstrumented UT curves in patients with AIS. METHODS The authors retrospectively reviewed a prospectively collected multicenter AIS registry for all consecutive patients with Lenke type 1–4 curves with a 2-year minimum follow-up. UT curves were considered uninstrumented if the upper instrumented vertebra (UIV) did not extend above 1 level from the lower end vertebra of the UT curve. The authors defined progression as > 5°, and divided patients into two cohorts: those with improvement in the UT curve (IMP) and those without improvement in the UT curve (NO IMP). Radiographic, demographic, and Scoliosis Research Society (SRS)–22 survey outcome measures were compared using univariate analysis, and significant factors were compared using a multivariate regression model. RESULTS The study included 450 patients (370 females and 80 males). The UT curve self-corrected in 86% of patients (n = 385), there was no change in 14% (n = 65), and no patients worsened. Preoperatively, patients were similar with respect to Lenke classification (p = 0.44), age (p = 0.31), sex (p = 0.85), and Risser score (p = 0.14). The UT curves in the IMP group self-corrected from 24.7° ± 6.5° to 12.6° ± 5.9°, whereas in the NO IMP group UT curves remained the same, from 20.3° ± 5.8° to 18.5° ± 5.7°. In a multivariate analysis, preoperative main thoracic (MT) curve size (p = 0.004) and MT curve correction (p = 0.001) remained significant predictors of UT curve improvement. Greater correction of the MT curve and larger initial MT curve size were associated with greater likelihood of UT curve improvement. CONCLUSIONS Spontaneous UT curve correction occurred in the majority (86%) of unfused UT curves after MT curve correction in Lenke 1–4 curve types. The magnitude of preoperative MT curve size and postoperative MT curve correction were independent predictors of spontaneous UT curve correction.

230. Impact of poor mental health on clinical outcomes in surgically treated adolescent idiopathic scoliosis patients

2019 ◽  
Vol 19 (9) ◽  
pp. S113
Author(s):  
Majd Marrache ◽  
Paul D. Sponseller ◽  
Caleb Gottlich ◽  
Baron S. Lonner ◽  
Aaron J. Buckland ◽  
...  
Keyword(s):  
Mental Health ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Clinical Outcomes ◽  
Poor Mental Health

scholarly journals Chiropractic rehabilitation for adolescent idiopathic scoliosis: end-of-growth and skeletal maturity results

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Mark W. Morningstar ◽  
Brian Dovorany ◽  
Clayton J. Stitzel ◽  
Aatif Siddiqui
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Skeletal Maturity ◽  
Exercise Program ◽  
Inclusion Criteria ◽  
Specific Exercise ◽  
Curve Correction ◽  
Total Correction ◽  
Radiographic Outcomes ◽  
Angle Measurements

The aim of this study was to evaluate the radiographic outcomes obtained in a sample of patients treated with a chiropractic scoliosis-specific exercise program for patients with adolescent idiopathic scoliosis. Patients were treated and subsequently followed through skeletal maturity, and their results were reported in accordance with the SOSORT Consensus Guidelines. A total of 60 patient charts were consecutively selected when they met inclusion criteria. Cobb angle measurements and Risser staging were collected on all images. Using SOSORT criteria, 51.7% of patients achieved curve correction and 38.3% achieved stabilization. In the curve correction group, average total correction was 12.75°. A small number of sampled patients’ curves progressed, with a 13% failure rate based upon patients who dropped out before skeletal maturity combined with those who had progressed at skeletal maturity. Future studies are needed to corroborate these observations.

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